Both your RA symptoms and your treatment may change with pregnancy. Here's what you need to know about having a baby when you have rheumatoid arthritis.

Rheumatoid arthritis (RA) is far more common in women than in men and generally strikes at an age when a woman may be planning a family.

But RA does not affect a woman's ability to get pregnant, and women usually don’t experience significant pregnancy complications because of RA, says Nicole R. Hall, MD, a maternal/fetal medicine specialist at Texas Children’s Pavilion for Women in Houston.

The joint pain and fatigue of RA can, however, make pregnancy more of a challenge.  

Darlene Rodriguez, 24, an expectant mother in Houston who was diagnosed with RA at age 18, says she’s felt more tired and achy during her first trimester.

She has particular trouble with her wrists, elbows, and fingers — and she loses strength in her hands and drops things. Cold weather makes her problems even worse.

Before deciding to start a family, women with RA should talk with their medical team about what to expect during pregnancy and ask if their current RA medications will be safe for a developing baby.

You may have to discontinue taking some of them months before conception to make sure the drug is out of your system before you get pregnant.

Some medications, such as methotrexate (Rheumatrex, Trexall) and lefunomide (Arava) can cause miscarriage or birth defects.

Tips for Navigating a Pregnancy with RA

Reduce your physical load Besides taking her medications, Rodriguez’s strategy to get through pregnancy is to cut back on her physical load and try to not overdo it.

“I know my limit,” she says. Rodriguez is using saved vacation time to cut back on her work hours as a full-time banker during the pregnancy.

Even though Rodriguez says she has not yet experienced a lessening of symptoms, Hall notes that the majority of women see their RA improve during pregnancy.

“The decrease in disease activity generally starts in the first trimester and typically lasts through the third trimester,” she says.

Why this happens isn’t known, but it’s probably due to hormonal changes and the fact that the immune system is relatively suppressed during pregnancy.

As a result, the autoimmune response at work in rheumatoid arthritis may be less active, Hall explains.

Reduce your medications In the third trimester, if you're taking nonsteroidal anti-inflammatory medications (NSAIDs) for your RA, your doctor will probably stop them because these drugs can cause complications with a baby’s heart.

Women who have been taking medications to suppress the immune system during pregnancy may be at an increased risk for infection, says Jennifer Sloane, MD, a rheumatologist at Thomas Jefferson University Hospital in Philadelphia.

If you’ve been taking steroids during your pregnancy, you may be at a higher risk of having premature labor, Dr. Sloane adds. Your baby also may be small for its gestational age.

Expect flares after childbirth If you’ve had a break from your RA symptoms during pregnancy, they may come roaring back shortly after your baby arrives.

“Approximately 90 percent of patients flare after delivery, usually within the first 6 weeks,” notes Hall.

So, just as you’re learning how to swaddle, diaper, and operate the car seat, you may need some TLC yourself to better manage your rheumatoid arthritis.

Talk to your medical team before you deliver to create a management strategy just in case your disease flares. Additionally, if you're going to breastfeed, know that certain medications still will be off-limits.

Having a plan in place before baby comes will help you be the healthiest new mom you can be.